TAMPA, Fla. — Choosing the right time to do a refractive lens exchange comes down to a few options, according to an expert.

In a presentation at the Telling It Like It Is meeting, J. Bradley Randleman, MD, provided four examples of when lens exchange can be used.

First is when the treatment needed exceeds the correction range of laser vision correction. This includes patients with high hyperopia at any age and older patients with high myopia.

“I’ve got a lot more I can do with them over time, and I’m going to stably reduce that hyperopia without doing a lot of things to their cornea,” Randleman said. “In high myopia, there are better options, particularly the ICL in younger patients, but in older patients, the lens exchange starts to be a good option.”

Second is when the desired outcome is not possible with laser vision correction, particularly in patients who want extended range of vision. While monovision is a common avenue, Randleman said it does not work for everyone, and patients who want more range of vision will likely need a presbyopia-correcting IOL.

The third scenario for lens exchange is when other factors limit laser vision correction and ICL (STAAR Surgical) surgery, including age, ocular surface issues and a need for long-term stability.

Randleman said the final scenario for refractive lens exchange is in patients undergoing bioptic procedures.

“This is something that is probably underutilized,” he said. “It requires a lot of preoperative planning. You have to make sure patients are laser vision correction candidates ahead of time.”